单疱病毒性角膜炎继发青光眼

单疱病毒性角膜炎(Herpes simplex keratitis，HSK)是眼科常见病，易复发致盲率高。浅层的HSK根据病史及眼部体征诊断多无困难，但继发青光眼的单疱病毒性角膜炎临床上表现较为复杂，治疗上也较为棘手。现将我院自1995～1999年收入院治疗的24例HSK继发青光眼的临床特征以及治疗、随访情况报告如下。     

单疱病毒性角膜炎继发青光眼

目的：探讨单纯疱疹病毒性角膜炎（herpes simplex keratitis,HSK）继发青光眼的诊治方法和疗效。方法：继发青光眼诊断标准为HSK患者眼压≥24mmHg。以角膜病变静止及停用降眼压药物1wk后眼压≤21mmHg为临床治愈。30例HSK继发青光眼患者给予综合抗病毒、抗炎及降眼压治疗。结果：单纯疱疹病毒性角膜炎继发青光眼患者30例经过抗病毒、抗炎及降眼压治疗均获临床治愈。结论：通过综合抗病毒与抗炎治疗HSK继发青光眼能迅速控制炎症与眼压。个体化的眼压测量对HSK继发青光眼的诊断是必要的。     

Herpes simplex keratitis

Avirulent strains of herpes simplex type 1 (HSV-1) infect and shed and colonize the ganglia in rabbits. This primary infection reduces the severity of subsequent infection by virulent virus and prevents ganglionic colonization by even very virulent neurotropic virus. Only a small proportion of the human population known to be infected with HSV-1 develops clinical disease. It is possible that the severity and likelihood of recurrence of this disease is determined by the virulence of the original infecting HSV-1 strain. In addition, there is evidence for differences in antigenicity among the various virus strains, and it may be that the development of stromal disease is related to the host response to these differences. Among the drugs generally available for the treatment of herpetic disease, trifluridine is currently the newest and most effective. Other compounds, such as acyclovir and BVDU, are being developed; because these drugs are specific for the virus and do not interfere with the metabolic processes of normal cells, they have a very low toxicity. Also, it may be that these compounds have a combined effect with other antiviral agents, such as vidarabine, increasing their potency against stromal disease and iritis.     

Herpes simplex keratitis

Chronic infection of the cornea by Herpes simplex virus (HSV) continues to be an important cause of unilateral blindness. Despite considerable progress in the understanding of the virus at cellular and molecular levels, the prospect of prevention still appears to be long way off. The development of non-toxic topical antiviral agents has been an important step forward in management. However, correct diagnosis and treatment, in particular, the avoidance of inappropriate use of topical steroid remains as important as ever. This article reviews the virological and clinical aspects of HSV keratitis including the current concepts of pathogenesis and management.     

Herpes simplex keratitis

This article reviews the current concepts for the diagnosis and treatment of Herpes simplex keratitis and its complications, discussing characteristics of the virus, the prevalence of the disease, chemical and clinical differentiation between Types I and II Herpesvirus hominis, and the many clinical presentations of Type I disease. The antiviral agents commonly in use are reviewed, covering the historical development of the drugs, indications for their use and the associated toxic and untoward reactions. An outline for the medical treatment of the different forms of Herpes simplex keratitis is given, as well as the indications for surgical intervention in the treatment of the disease. The surgical complications and results following keratoplasty are discussed.     

Herpes simplex keratitis after ophthalmic surgery

PURPOSE: We report 6 cases of herpes simplex keratitis after ophthalmic surgery, in eyes without clinical history of herpes simplex keratitis. CASES: These cases comprised 6 patients examined at our hospital between April 1992 and November 2001. Past operations were keratoplasty in 5 eyes and cataract surgery in 1 eye. Clinical findings and predisposing factors were evaluated retrospectively. The period between herpetic epithelial keratitis onset and ophthalmic surgery ranged from 1.5 to 79 months. Predisposing factors included corticosteroid therapy and operative wound. The herpetic epithelial lesions were dendritic ulcers in 2 eyes, geographic ulcer in 1 eye, and atypical epithelial lesions in 3 eyes; in all cases, herpes simplex virus (HSV)-DNA was detected by polymerase chain reaction (PCR) in tear fluid. All herpetic epithelial lesions healed with oral and topical acyclovir. CONCLUSIONS: When corticosteroids are used following ophthalmic surgery, physicians should be alert to the possibility of herpetic epithelial keratitis, even in patients with no clinical history of herpes simplex keratitis. PCR detection in tear fluid is helpful in diagnosing this disease.     

Herpes simplex keratitis in children.

Ophthalmic findings are reported in 31 eyes of 28 children with herpes simplex keratitis. Twenty two had dendritic ulcers, and nine had geographic ulcers or disciform stromal keratitis. After resolution of keratitis, 80% (19/22) of children with dendritic ulcers achieved corrected visual acuity of 6/9 or better, 50% (11/22) had induced astigmatism, 45% (9/22) had one to five recurrences. In the group with geographic or disciform lesions, 89% (8/9) had reduced corrected vision, 78% (7/9) had induced astigmatism which was predominantly against the rule, and 87% (7/9) had one to six recurrences.     

Herpes simplex keratitis after cataract surgery

PURPOSE: Herpetic keratitis is a rare complication of cataract surgery. We describe 3 cases of herpes simplex keratitis after cataract surgery in eyes with no clinical history of this disease. METHODS: Three patients underwent uneventful phacoemulsification of cataract with intraocular lens implantation. All were treated postoperatively with topical steroids. On subsequent development of corneal dendritic epithelial lesions in the operated eyes, the corticosteroids were replaced by treatment with topical acyclovir. RESULTS: The first postoperative day was uneventful. Corneal dendritic epithelial lesions were observed 1-5 weeks postoperatively and healed without sequelae after topical acyclovir treatment. CONCLUSIONS: In view of the surgical trauma along with the topical corticosteroid treatment commonly prescribed after cataract surgery, physicians should be aware of the possible development of herpetic epithelial keratitis even in patients with no clinical history of this disease.     

Herpes simplex virus keratitis in children

PURPOSE: To describe the spectrum and recurrence of herpes simplex virus (HSV) keratitis in children and adolescents. DESIGN: Retrospective cohort study. METHODS: Twenty-three patients younger than age 16 years were diagnosed with HSV keratitis at one institution. RESULTS: All children presented with dendritic or punctate epithelial keratitis, and stromal keratitis occurred concurrently with epithelial keratitis in 14 patients (61%). Six patients (26%) had bilateral HSV keratitis. Eleven patients (48%) developed recurrent HSV keratitis at a median of 15 months after the first documented episode. Amblyopia occurred in three children. CONCLUSION: Children with herpetic keratitis may have bilateral ocular involvement and are at risk for recurrent keratitis and amblyopia.